Sargeant I R, Loizou L A, Tulloch M, Thorpe S, Brown S G
National Medical Laser Centre, University College Hospital, London, United Kingdom.
Gastrointest Endosc. 1992 Mar-Apr;38(2):165-9. doi: 10.1016/s0016-5107(92)70383-6.
Overgrowth of an esophageal prosthesis by cancer is a late complication of insertion which presents a difficult management problem. We have treated 14 such patients; 9 had Celestin tubes and 5 Atkinson tubes in situ for a median of 7 months. The median patient age was 75 years; 3 had squamous cell carcinomas and 11 adenocarcinomas; 12 were at the lowest thoracic esophagus or cardia, and 2 were anastomotic. Eleven tubes were overgrown at the top, two at the bottom only, and one at both ends. Dysphagia was graded from 0 to 4 (0 = normal; 4 = dysphagia for liquids). All patients but one improved with treatment. The median pre-treatment grade was 4 (range, 2 to 4) and post-treatment was 2 (0 to 3). This improvement was significant (p less than 0.01) Wilcoxon-signal rank). Most patients required only one or two endoscopies. The median survival was 9 weeks from first laser session (range, 3 to 36 weeks). We feel these results justify laser treatment in most patients in whom cancer overgrowth causes blockage of an esophageal prosthesis.
食管癌性组织过度生长覆盖食管假体是假体植入术后的一种晚期并发症，处理起来较为棘手。我们共治疗了14例此类患者；其中9例植入了Celestin管，5例植入了Atkinson管，中位植入时间为7个月。患者的中位年龄为75岁；3例为鳞状细胞癌，11例为腺癌；12例病变位于食管最低段或贲门部，2例位于吻合口处。11根假体上端被癌组织覆盖，2根仅下端被覆盖，1根两端均被覆盖。吞咽困难程度按0至4级分级（0级=正常；4级=液体吞咽困难）。除1例患者外，所有患者经治疗后均有改善。治疗前吞咽困难程度的中位分级为4级（范围2至4级），治疗后为2级（0至3级）。这种改善具有显著性（p<0.01，Wilcoxon符号秩检验）。大多数患者仅需进行一或两次内镜检查。自首次激光治疗起，患者的中位生存期为9周（范围3至36周）。我们认为，对于大多数因癌组织过度生长导致食管假体堵塞的患者，这些结果证明激光治疗是合理的。
